- Cheek biting can be caused by misaligned teeth or behavioral factors.
- Chewing, biting, or constant pressure on the inside of the cheeks results in lesions or ulcers.
- A range of treatment options are available to address both the causes and symptoms.
While cheek biting often occurs as the result of a misalignment of the teeth or jaw, in certain cases it may be linked to stress factors or compulsive behavior disorders.
Regular cheek biting can cause irritation to the inside of the cheek, resulting in chronic discomfort, lesions in the mouth, canker sores or ulcers.
Here we explore the causes, consequences, and treatments available for cheek biting.
Causes of Cheek Biting: Malocclusion
Ideally, the teeth should fit easily inside the mouth, with the teeth of the upper jaw slightly overlapping the teeth of the lower jaw. Teeth should not be rotated or twisted.
Malocclusion or misaligned teeth represent one of the major causes of cheek biting. When the upper teeth are misaligned because of a crossbite, crowding, or crooked teeth, the cheek is not properly protected and can easily find its way between the upper and lower molars.
Developmental issues most commonly seen during childhood can sometimes cause cheek biting. Misaligned teeth often result from airway obstructions, breathing issues, and habits such as thumb sucking or tongue thrusting.
According to Dr. Mark Duncan of Aesthetic Dentistry in Georgetown, TX, teeth are naturally designed to be self-aligning. During childhood they erupt into neutral space, with their long, flat sides guiding them to form a U-shape. The tongue is also instrumental in pushing the sides of the teeth outwards and into the right position.
However, it is increasingly common that children’s teeth erupt misaligned.
“Unfortunately, today there are so many additives, toxins and allergens in our environment that it is more common to have the teeth erupt into a suboptimal alignment,” says Dr. Duncan. “Issues early in life can lead to an overgrowth of the tonsil tissue and changes in breathing.”
These irritants may cause a child to breathe through the mouth instead of the nose, thus preventing the tongue from effectively guiding teeth and jaw development. Mouth breathing can therefore result in structural issues such as cross bites, which in turn lead to symptoms such as cheek or tongue biting.
Children who engage in tongue thrusting or thumb sucking often require a dental appliance to break the habit and prevent misalignment.
Misalignment can also occur during adulthood as a result of dental work or tooth extraction, which may cause the opposing tooth to move towards the cheek.
Restorative and cosmetic dentist Dr. Donald Wilcox of Glendale, AZ explains, “When dentists do restorative work in this area, especially with crowns, the relationship between the molars can be altered slightly and create a situation where cheek biting may occur.”
Teeth that are misaligned or painful to bite on can also lead to cheek biting, as the individual tries to avoid the bothersome tooth when they are chewing.
Another cause — but to a lesser degree — is weight gain. Cheeks become more prominent and interfere with the posterior molars when chewing. “Extra fat can be deposited in the cheek and neck areas, leading to cheek biting and a narrowing of the airway,” elaborates Dr. Wilcox.
Psychological Causes of Cheek Biting
In some cases cheek biting can be classified as a body-focused repetitive behavior (BFRB), much like nail biting or hair pulling. When it isn’t caused by dental issues, it generally occurs as a symptom of any of the following psychological or behavioral patterns.
- Nervous habits that are difficult to control
Roughly 3% of the population is afflicted with BFRB. These various forms of repetitive behavior can cause significant physical and emotional distress. Sometimes, cheek biters begin repetitive biting because they notice a bump or uneven texture on the cheek lining. This generally exacerbates the roughness, making the lesion more prominent and causing further temptation to bite. Often, people are unaware they are even biting their cheeks.
- Excess stress
Repetitive chewing or biting of the cheek can develop as a response to high levels of stress, and may be done unconsciously.
“The most common cause is excessive activity of the jaw muscles, which creates a contact between the teeth and the soft tissue of the cheek,” says Dr. Wilcox. “This can be a nervous habit where people will bite their cheek as a subconscious outlet for stress during waking hours.”
- Jaw clenching
Cheek biting may also be linked to bruxism, an oral disorder characterized by the clenching or grinding of the teeth and jaw. This repetitive action can traumatize the soft cheek tissue. Bruxism can occur during both sleep and waking hours.
Consequences of Cheek Biting
Generally, cheek biting causes damage to the mouth’s lining by creating painful inflammation, swelling, tears, and sores. Some cheek bites manifest as minor lesions that heal relatively quickly; others can result in severe lesions that may require stitches.
- Traumatic sores and ulcers
Many cheek bites result in a sore similar to a canker sore or ulcer. They can be extremely painful and become infected.
The body attempts to defend itself from chronic trauma by creating a protective coating of keratin within the mouth. The keratin forms a hard patch, as the body produces extra cells to protect the soft tissue of the cheek.
Hyperkeratosis is usually found where the cheek tissue is in contact with the teeth, and may appear as a gray-white line or lesion. Since the keratin is hard and protrudes slightly from the inner cheek, this increases the temptation to bite or chew, further increasing irritation and damage. Repeat trauma to the cheek tissue causes inflammation, tenderness, and swelling.
- Oral cancer
Chronic irritation of the inner cheek is also linked to oral cancer. Oral sores caused by trauma may result in excessive cell growth, leading to cancer.
Treatments for Cheek Biting
Your first reflex should be to see your dentist for a thorough check-up. As Dr. Duncan explains, “Typically, if the dentist does a careful enough health history and examination, there will be a multitude of other things along with cheek biting that could be uncovered.”
Dr. Duncan advises a comprehensive health check that takes into consideration the cause of the cheek biting, and other related symptoms such as sleep apnea or headaches. A thorough and accurate diagnosis will help determine the most appropriate course of treatment.
Depending on the cause and severity of the cheek biting, possible treatments include:
- Braces or dental work
Misalignment of the teeth can be corrected with orthodontic treatment if significant bite issues exist. A minor discrepancy can sometimes be corrected by reshaping the teeth responsible for the biting. If new dental restorations have created the problem, they must be reshaped.
- Dental guard
Mouth guards protect the teeth during sleep from unconscious biting or tissue damage caused by jaw and teeth grinding. A daytime dental guard can also be worn if necessary.
- Weight loss
Cheeks that have become larger due to weight gain will respond to weight loss.
- Prescription mouthwash
Prescription mouthwash can help keep the mouth clean and minimize bacteria if cheek biting has caused ulcers or lesions.
- Laser treatments
Laser treatments can efficiently cauterize any hardened scar tissue, leaving a smooth surface. This can help reduce the desire to bite and allow the cheek tissue to heal.
- Relaxation and mindfulness
For habitual anxious cheek biters, identifying the source of stress and modifying responses to it is essential to treating the disorder and promoting better long-term health in general.
Dr. Wilcox also recommends engaging mindfulness techniques to help eradicate repetitive cheek biting. He explains, “During the day, becoming aware of the habit is the first step to taking steps to breaking it. Various stress relief techniques could be employed to lessen the activity.”
Successful stress reduction techniques may include regular exercise, breathing practices, getting to bed early, and staying away from screens or mobile devices several hours before bedtime. Sometimes anti-anxiety medications can be beneficial for more serious conditions.
Cheek biting may appear to be a relatively innocuous habit, but is actually symptomatic of more serious issues that should be addressed. If your cheeks are lined with ulcers or lesions, consider making an appointment to see your dentist.